Anesthetics: History, Exam
  1. Surgical history
  2. Drug history
  3. Cardiac
  4. Pulmonary
  5. Alimentary
  6. Nervous
  7. Urogenital
  8. Anxiety level
Surgical history
  • Any prior operations.
Drug history
  • Reactions to anesthetic during previous operation.
  • Family history of reaction to anesthetic (malignant hyperthermia).
  • Drugs currently taking, took in past.
  • Allergies to drugs: dye and esp. antibiotics that you might need [differentiating s/e from allergy very important here].
Cardiac 
  • Activity level.
  • MI, angina.
  • HTN.
  • Murmurs.
  • IE, prosthetic valve (antibiotic prophylaxis needed).
  • Listen to heart sounds. See Cardiac Examination.
  • BP.
Pulmonary
  • Smoking: ever smoked, how many per day, for how long, type [cigarette, pipe, chew].
  • Dyspnoea.
  • Asthma, bronchitis, TB, CF.
  • Chest infections.
  • Listen to lungs. See Lung Examination.
Alimentary
  • Inspect: is patient obese?
  • Goitre (impinges airway).
  • Operations on throat.
  • Reflux problems, heartburn (aspiration risk).
  • Seasickness in past (more likely vomiting from drugs).
  • Dentures.
  • Loose crowns, bridges.
  • How far can pt open mouth?
  • Pt sticks out tongue, Dr. looks at back of throat.
  • Cervical injury
  • Can pt touch chin to chest, move up and down.
  • TMJ problems: never broken it, doesn't lock, doesn't click.
  • How long have been fasting.
  • Alcohol (heavy drinker needs more propofol).
  • Speaking, throat problems [avoids post-op blame].
Nervous
  • Epilepsy (propofol contraindicated).
  • Other nervous disorders [avoids post-op blame].
Urogenital
  • OCP
  • No chance currently pregnant (drugs teratogenic and abortion risk, aspiration risk from morning sickness).
Anxiety level
  • How do you feel about operation?
  • If very anxious, give a benzodiazepene.